Associated prognostic impact of opioid use before Transcatheter aortic valve implantation – A Danish nationwide cohort study

Abstract

Background Opioid use is frequently reported as a baseline characteristic in transcatheter aortic valve implantation (TAVI) cohorts, yet its prognostic implications have not been examined. Aim To examine the association between pre-procedural opioid use and post-TAVI outcomes. Methods Using Danish nationwide registries, we identified patients undergoing TAVI between 2015 and 2022. Patients were categorized according to opioid use within one year before TAVI. We examined one-year all-cause mortality, cumulative days of hospitalization including the composite outcome of death or > 14 cumulative hospitalization days, and a potential opioid dose-response relationship. Adjusted relative risks were estimated using multivariable Cox and logistic regression. Results We identified 6505 patients: 1265 (19.4%) with opioid use (48.9% male; median age 80 years) and 5240 (80.6%) without (59.4% male; median age 81 years). The two groups were comparable in cardiac comorbidities and malignancy but differed in musculoskeletal (back disorders: 45.9% vs 20.7%; arthropathies 65.3% vs 47.1%) and psychiatric conditions (antidepressants: 18.8% vs. 9.6%; anxiolytics/hypnotics: 23.7% vs. 12.4%). Baseline opioid use was associated with higher post-TAVI mortality (10.4% vs 6.9%; adjusted HR 1.35, 95% CI 1.11–1.66) and increased risk of the composite outcome (OR 1.47, 95% CI 1.25–1.72). A dose-response relationship was observed, with one-year mortality increasing from 7.0% in non-users to 8.8% in low-dose users and 12.1% in high-dose users. Conclusion Baseline opioid use was associated with increased mortality and hospitalization burden in the year following TAVI, and this relationship was aggravated among high-dose users. The observed associations were most likely driven by the underlying condition of the opioid therapy.